Diverticulitis is a painful condition that’s caused by infection within the wall of the diverticula. If you’ve ever had one, you know how hard they can be to treat. The best treatment is to prevent this from happening in the first place, which is why it’s important to eat a low-carb, high-fat diet. These diets have been proven to not only protect against diverticulitis, but also to prevent it from ever forming in the first place.

The most common cause of diverticulitis is infection that begins in the bowel, which is known as diverticulosis. For many years, doctors recommended that people with diverticulosis only have a small amount of the diverticulitis-causing bacteria, but they were wrong. Now we know that everyone who has diverticulitis should be treated for diverticulosis. Even if they don’t have any symptoms, diverticulosis could be putting your health at risk. If you have diverticulosis, you should take steps now to prevent your condition from getting worse. This could mean taking antibiotics, getting surgery, or even trying a low-carb, ketogenic diet.

From , medical opinion from – Updated 18. June 2021

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What is your main health goal?

If you have ever had an attack of diverticulitis, caused by inflammation or infection of a small sac in the lower intestinal wall, you will probably never forget it.

Intense, stabbing pain, usually in the lower left abdomen, has probably caused you to curl up in pain. The pain can also radiate to the lower abdomen, the navel, or even the back or side.

If the attack was severe, possibly due to a perforation (hole) in the intestinal wall, you may need to be admitted to hospital for treatment or have emergency surgery.

Of course you want to do everything you can to prevent another attack.

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What is your main health goal?

Questions about the low-carb diet

If you’ve had diverticular disease and are considering switching to a low-carb or keto diet to lose weight, manage your diabetes, or for other medical reasons, you may be wondering:

  • Is a low-carb or keto diet safe if I have a history of diverticulitis?
  • Can a low-carb or keto diet increase the risk of diverticulitis recurrence?
  • Can a low-carb or keto diet help prevent future seizures?

This evidence-based guide helps answer these questions. It describes what is and is not known about diverticulitis and highlights the risk factors that can trigger the disease.

The guidelines also discuss current research on foods that should be eaten or avoided to prevent a recurrence of diverticulitis and during an acute attack of diverticulitis.

What we know and what we do not know

A word of warning: As with the low-carb diet or the keto diet, there have been no good studies on diverticulitis and this type of diet. Well-designed randomized controlled trials are urgently needed.

In order to fill the gap in existing knowledge, an international panel of medical experts and gastroenterologists was consulted in the preparation of this guide, who are listed in our Find a low-carb doctor table.

The general consensus among low-carb experts is that someone with a history of diverticular disease can safely follow a low-carb or keto diet without increasing the risk of recurrence of this serious and painful condition.

Their clinical experience shows that the low-carb keto diet effectively helps patients reduce risk factors for a first attack or relapse by reducing obesity, metabolic syndrome, and chronic inflammation, and by eliminating refined carbohydrates and sugars from the diet.

As an American gastroenterologist and author of this textbook, I agree with this clinical opinion. I regularly recommend a low-carb diet to almost all of my patients with gastrointestinal problems. In my clinical practice and research, I have no hesitation in recommending a low-carb or keto diet to anyone with diverticular disease.

However, in the absence of good, definitive scientific evidence, you need to be sure that you are making the decision that is right for you. Read on for a more in-depth discussion of these complex issues related to a common health problem.

What is diverticulitis?

Diverticulitis occurs when small sacs in the wall of the intestine become inflamed or infected. In the most severe cases, even a perforation or rupture can occur with leakage of the intestinal contents into the surrounding tissue.

These pockets are called diverticula. They look like small pits on the inner wall of the colon. The presence of diverticula is called diverticulosis and usually causes no symptoms.

Why do diverticula form in the first place? It’s not clear. It is thought to be a combination of aging and heredity combined with other triggers such as smoking, diet or inflammation.

In sensitive individuals, muscle contractions in the colon cause localized areas of increased pressure as gas and waste move through the digestive tract. It is thought that this pressure creates pits and pockets in weak places in the muscle that surrounds the bowel. These weaknesses are located where the arteries enter the wall of the colon.

If diverticulosis usually causes no symptoms or problems, why does diverticulitis suddenly appear? Fecal matter would be trapped or blocked in the diverticula, causing tissue irritation, pain and infection. This process can cause tissue breakdown, resulting in a cavity or hole. More serious complications, such as an abscess or fistula, may occur. A fistula is an abnormal connection that leads to other tissues, such as the bladder, vagina, or even the skin.

There may also be constipation or obstruction of the colon. A more serious complication, even fatal, is a free perforation in the abdominal cavity, which causes extensive infection (peritonitis).

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Diverticula are sacs or pouches located in the colon.

In the case of diverticulosis, these sacs usually do not cause any problems or symptoms, but in a small percentage of people, the sacs can become inflamed or infected, which is called diverticulitis. In complicated cases of diverticulitis, the sacs may even perforate, leading to serious complications.

How common is this disease?

Diverticular diseases are common in Western countries. In fact, in the last century it was considered a disease of Western civilization.

The incidence of diverticular disease increases when people migrate to developed countries or when entire countries adopt a more western lifestyle. The incidence of diverticular disease is now increasing in other parts of the world, for example. B. in Africa and Asia, where it was formerly very rare.

With the increase in colonoscopies in recent decades, diverticulosis is now one of the most common incidental findings.

Recent studies have shown that only 4% of patients with diverticulosis develop diverticulitis.

But because diverticulosis is so common, millions of people in western countries suffer from a debilitating bout of diverticulitis each year. In the United States alone, diverticulitis accounts for more than 2.7 million outpatient visits and 200,000 hospitalizations each year.

Another worrying trend is the increasing incidence of diverticulitis, especially in people under the age of 50, in whom this condition used to be very rare. This growth at a younger age is worrying. The younger you are when you are diagnosed with diverticulosis, the greater your risk of developing diverticulitis and having recurrent attacks.

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Diverticular diseases occur in all western countries, especially with increasing age. However, less than 5% of people with diverticular disease develop diverticulitis. The incidence of diverticulitis has increased in recent years, especially in people under the age of 50.

Risk factors for diverticular disease

Since diverticula are so common and often occur without symptoms or problems, what are the other important risk factors for their occurrence and for the development of diverticulitis, besides age?

Data from studies conducted to date include:

  • Genetics: If someone in your family has diverticulitis, you are at increased risk of getting it yourself. Recent studies suggest that genetic factors may be responsible for up to 50% of the risk of developing diverticular disease.
  • Smoking: People who smoke have a higher risk of developing diverticulosis and have a higher risk of complications from diverticulitis. Women who smoke are at greater risk than men who smoke.
  • Obesity: Obesity and excessive weight gain in adulthood increase the risk of diverticulosis and diverticulitis. Overweight people have more serious complications with diverticulitis.

It has been suggested, but not proven, that the risk is more related to changes in the gut microbiome, probably due to consumption of highly processed sugars and starches.

  • Physical inactivity: A sedentary lifestyle is also associated with the formation of diverticula and their development into diverticulitis. Overweight men with an inactive lifestyle are at particularly high risk. Observational studies show that vigorous exercise, such as running, can reduce risk, even in overweight or obese people.
  • Diabetes: In patients with diverticular disease, the diagnosis of diabetes increases the risk of diverticulitis, hospitalization, and more serious complications.
  • Medication: Certain types of drugs, including steroids, medications and non-steroidal anti-inflammatory drugs (NSAIDs – common painkillers such as ibuprofen, naproxen) increase the risk of diverticulitis and more serious complications.
  • Ignition: Chronic low-grade inflammation, with or without obesity, is becoming a major risk factor for diverticulitis. It is now believed that low-grade inflammation plays an important role in the eventual formation of diverticula. As mentioned earlier, food choices can play an important role in the development of inflammation.
  • Vitamin D: Low vitamin D levels have become a possible risk factor for attacks of diverticulitis. Seasonal and geographic variations in the incidence of diverticulitis are consistent with sun exposure and presumed vitamin D status. Studies have shown that low vitamin D levels are significantly associated with a higher incidence of diverticulitis and more serious complications. This does not mean that vitamin D supplements prevent diverticulitis. More research is needed to determine if it is vitamin D or other factors that influence diverticulitis.
  • Diet: For decades, diet was considered the most important risk factor, especially a low-fiber diet. However, the results of recent studies are inconsistent and contradictory, casting doubt on the nutritional factors. What is currently known about the role of different foods to eat or avoid is explained in the next section.

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Several risk factors have been associated with a higher incidence of diverticular disease, including advanced age, genetics, smoking, obesity, hypodynamia, diabetes, inflammation, an altered microbiome, and possibly vitamin D deficiency. Dietary factors have been proposed as a risk factor, but the results are contradictory.

Foods to eat or avoid

What foods should I eat to prevent diverticular disease? Which products should I avoid?

The role of certain food groups in causing and preventing diverticular disease has been studied for decades. However, these studies are still highly controversial and full of contradictory results.

Here’s what current research says about some foods:

Fiber

For decades, insufficient fiber and the resulting constipation were thought to cause diverticulosis and increase the risk of diverticulitis. But, as one prominent researcher recently noted, the fiber deficiency hypothesis has been around for four decades without any evidence.

In the last decade, some studies have shown that eating more fiber does not prevent diverticula from forming.

Similarly, several recent studies have shown that, contrary to 50 years of medical dogma, constipation is virtually unrelated to diverticular disease.

Some studies even show that a high-fiber diet and more frequent bowel movements may be associated with the development of diverticula.

But here’s where it gets complicated. Although a high-fiber diet cannot prevent diverticulosis, observational data suggest that a high-fiber diet may reduce the risk of acute diverticulitis and prevent more serious complications.

Whether an increase in dietary fiber increases the risk of developing diverticulosis but decreases the risk of developing diverticulitis requires further investigation. Conflicting results may also be related to the type of dietary fiber consumed, such as whether the fiber is soluble or insoluble, and whether the fiber comes from fruits and vegetables rather than grains or bran.

However, a high-fiber diet appears to be beneficial for overall health, independent of diverticular disease. Read this scientific guide to better understand the different types of fiber and how to get more low-carb fiber into your diet: 15 Foods high in fiber and low in carbohydrates.

Nuts, seeds and popcorn

For decades, health professionals and the general public have believed that if you have diverticulosis or diverticulitis, you should avoid eating nuts, seeds and popcorn.

It was thought that these hard, undigested pieces were more likely to enter the diverticular sacs and scratch or irritate them, leading to inflammation and infection.

However, the advice to avoid foods such as popcorn, raspberries, strawberries, blackberries and nuts was based on a logical assumption and was not supported by scientific evidence. In 2008, a large prospective study following more than 47,000 men for 18 years found no association between the consumption of nuts, seeds and popcorn and the incidence of diverticulitis. Men who ate the most nuts and popcorn were less likely to have diverticulitis than those who ate the least.

Meat

Observational data show that consumption of large amounts of unprocessed red meat is associated with an increased incidence of diverticulitis in men.

In this study, as in many other studies on meat consumption in recent years, men with the highest red meat consumption tended to smoke more, take NSAIDs more often, and exercise less than men with the lowest meat consumption. This is called the healthy user bias.

In addition, the study suffers from many other methodological flaws of observational feeding studies, including the fact that the difference in relative risk between the highest meat eaters and the lowest was very small.

The evidence-based guidelines on red meat elaborate on the poor quality of observational data, which makes it very difficult to draw meaningful conclusions about the effects of red meat consumption on various health problems.

A healthy or sensible diet – or no special diet at all?

Some researchers recommend following a healthy, non-Western or conservative diet to reduce the risk of diverticulitis. What does that mean? Researchers describe the Western diet as having a high consumption of red and processed meat, refined grains, sweets, chips and high-fat dairy products. A sensible diet is defined as one rich in fruits, vegetables, whole grains, legumes, poultry and fish.

What part of a sensible diet actually reduces risk? Perhaps avoiding refined grains and sweets is an important part of reducing the risk of diverticulitis? This research question has not been answered.

A small but influential study showed that in an uncomplicated (or less severe) attack of diverticulitis, diet was not important, that an unrestricted or liberal diet produced the same results as those who restricted certain foods. This discovery, along with other controversial diet studies, has led many doctors and nutritionists to stop recommending specific diets.

However, many people with recurrent diverticulitis find that certain foods often precede their attacks and learn to identify and avoid their personal triggers. Paying attention to possible dietary triggers can help you control diverticular disease.

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The role of a high-fiber diet in diverticulosis and diverticulitis is currently questioned and complicated by weak association data.

Nuts, seeds and popcorn do not seem to be associated with seizures.

The general advice is to stick to a healthy or reasonable diet, but special restricted diets are not essential and people should find a diet that suits them.

Low-carbohydrate ketogenic diet

Many people turn to the low-carb or keto diet because they are looking for help with obesity and diabetes. Since these conditions are also major risk factors for diverticulosis, it is natural for people considering switching to a low-carb diet to wonder if they can follow the diet without worsening diverticulosis.

As mentioned at the beginning of this guide, there are currently no high-quality studies comparing low-carbohydrate or ketogenic diets to other dietary models in patients with diverticular disease.

Expert panels and gastroenterologists have been consulted and recommend low-carb diets on our Find a Doctor page. Based on his clinical experience, this diet is safe for people with diverticular disease.

They give the following reasons for recommending a low-carbohydrate diet for patients with diverticular disease:

  • The undiscovered role of sugar and refined carbohydrates in the development of diverticular disease: As a disease of western civilization, diverticulitis has increased since the 1860s along with the consumption of sugar and refined carbohydrates. In 1971, a very influential scientific article stated that a diet high in sugar and refined carbohydrates could be a major risk factor for diverticular disease. However, this observation about the role of sugar and refined carbohydrates was ignored in favor of the fact that a low-fiber diet was responsible for diverticular disease over the next 50 years.

To date, there have been no studies on the possible link between consumption of high sugar, refined carbohydrates and processed foods. We believe that these dietary groups should be studied given the risk factors obesity, diabetes and chronic inflammation that underlie diverticular disease.

  • Obesity: A low-carbohydrate or ketogenic diet is effective for losing and maintaining weight.
  • Diabetes: A low-carb or ketogenic diet is an effective way to lower blood sugar and can reverse diabetes.

Anecdotally, many people who follow a low-carb or ketogenic diet report an improvement in other inflammatory and gastrointestinal symptoms, including a reduction in irritable bowel syndrome (IBS), heartburn (acid reflux), and inflammatory bowel disease.

Our guide on irritable bowel syndrome and the keto diet includes a more in-depth look at the research and clinical experience on this other common bowel condition.

There are testimonials from Ruth and Jennifer about how they experienced significant improvement in their diverticular disease symptoms on the ketogenic diet.

Ketogenic diet for beginners

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Studies show that obesity, diabetes, metabolic syndrome and chronic inflammatory markers respond well to a low-carbohydrate ketogenic diet. Since these factors are risk factors for diverticular disease, reducing them may help reduce the risk of developing diverticulitis. Moreover, there is increasing anecdotal evidence that the symptoms and flare-ups of diverticular disease can be reduced with a low-carb diet. However, there are no scientific studies to support this claim.

Intermittent fasting

During an attack of diverticulitis, doctors recommend that patients drink only clear liquids for two to three days or until symptoms improve. In the case of a more severe infestation (complicated diverticulitis), it is recommended that nothing be taken by mouth until the diverticulitis has healed. This is a therapeutic form of intermittent fasting for gut health.

A full liquid diet includes water, sparkling water, mineral water, unsweetened tea, black coffee, consommé and bone broth. Some doctors allow clear sweetened juices, jellies, sweetened beverages or diet drinks with artificial sweeteners, but low-carb doctors like myself and other panelists recommend avoiding all liquids with sugar and artificial sweeteners.

My clinical opinion: If you are on a low-carb diet and have an exacerbation of diverticulitis, you should fast for a few days and drink only clear drinks. But if you feel better, you can return to a low-carb diet.

Can switching to intermittent fasting at times other than acute attacks help prevent or reduce outbreaks of diverticular disease?

Unfortunately, there are no studies on the possible role of regular periods of intermittent fasting on diverticular disease. Good research is needed. Nevertheless, it can be logically argued that periods of fasting may be beneficial for the underlying intestinal pathology of diverticular disease.

Short-term intermittent fasting, such as. B. Skipping breakfast or one meal a day (OMAD), is probably not dangerous for a person with diverticular disease and may help with weight loss, diabetes and blood sugar control.

For more information on intermittent fasting, check out the guides and videos.

All guidelines for intermittent fasting

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For the treatment of acute diverticulitis, it is recommended to fast for two to three days and use only liquids.

There is insufficient research to support the regular use of intermittent fasting to prevent outbreaks of diverticular disease, but intermittent fasting is effective for important risk factors such as obesity and diabetes.

The clinical opinion of low-carb dietitians is that fasting is safe and may even be beneficial for diverticular disease.

Summary

Diverticular disease is common in all western populations, especially in the elderly. Obesity, diabetes, smoking, hypodynamia and chronic inflammation are all risk factors.

A high-fiber diet is unlikely to prevent the development of diverticular disease, but it can reduce complications and hospitalization for acute attacks.

Doctors and nutritionists no longer recommend specific, restrictive diets for diverticular disease. That’s why we encourage you to find a diet that works for you and makes you feel healthier. For many people, this may be a low-carb or ketogenic diet.

There are no research data yet that would allow conclusions to be drawn about a low-carbohydrate diet, a keto diet, or intermittent fasting in relation to diverticular disease. However, clinical experience and patient testimonials indicate that both diets and intermittent fasting are not only safe, but may also be beneficial to overall digestive health.

Frequently Asked Questions

Can a low carb diet cause intestinal problems?

Some people experience intestinal problems when they start a low carb diet. This is because the body has to adjust to using ketones as its primary fuel source. The body may also have trouble digesting certain foods, such as dairy products and grains, which are high in carbohydrates.

Is a high fat diet bad for diverticulitis?

A high fat diet is not bad for diverticulitis.

Can keto diet cause digestive problems?

The ketogenic diet is a high-fat, low-carbohydrate diet that has been used for centuries to treat epilepsy and other neurological disorders. The keto diet is becoming increasingly popular as a weight loss method. Some people who follow the keto diet experience digestive problems, such as constipation or diarrhea. This can be due to the lack of fiber in the diet, which can lead to an increase in bowel movements and gas. Some people also experience a change in their gut microbiome, which can lead to digestive problems.

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